This invention is directed to a system for maintaining large number of patient medical records, for providing the patients with access to their personal records, and which can provide patient health and treatment records, including many categories of medical history, to the person's medical practitioner, using a network such as a local network, a wide area network, or a global computer network such as the Internet.
There is at present a need for real-time access to patient information. The availability of patient information to the practitioner can benefit the cost and quality of medical care, by speeding the examination process, eliminating duplicate testing, eliminating duplication of services, documenting physician care, and reducing the chance of mistake. At present, there is a lack of efficient patient information flow between segments of the healthcare industry. The patient information systems that are currently in use are either primarily physician-based, hospital-based, or insurance-based, and not patient-based. These systems are interactively limited, are quite expensive, and do not provide any simple access tool for the patient or for the medical community.
At present, it has been reported that physicians spend up to 58% of their time documenting patient care. Other research indicates that 30% of patient encounters now occur without the physician having access to the patient's charts. Also, as much as 90% of emergency department visits occur without the physician having any knowledge of the patient's medical history or prior medical treatments. At the same time, studies show that 11% of all medical laboratory testing is redundant and unnecessary, adding at least one billion dollars ($1,000,000,000) annually to America's medical costs. Other research indicates that about 33% of elderly admissions were the direct result of contraindicated drugs.
A number of computerized systems for tracking patient medical records have been previously proposed, but these do not address the problem of how to provide patients with access to a centralized repository of their medical records and health data. These prior systems do not provide the physicians that the patient may visit with the patient's medical history, allergies, medication data, or other important health data.
A prior approach, as discussed in McNerney Published Appln. US 2003/0088441, deals with a patient medical record system in which relevant patient medical information is accessed via a CD/ROM, with the records being stored at a central server. X-rays and prescriptions can be included in the medical records that are uploaded to the server. While the patient can access his or her own medical files, this requires using a special kiosk that is located at the healthcare provider's location, and the patient interface is basically limited to entering patient personal information.
Wilkins U.S. Pat. No. 6,523,099 relates to an individualized patient medical record system, where the patient can later review his or her own medical records. The patient carries a digital record on his or her person, with the entire medical record being stored on a portable data memory device, e.g., a CD-ROM.
What appears to be lacking in the previously proposed systems is a patient health care record system that is easily accessed, e.g., from a web site or by inserting a CD/ROM in to a computer, whereby the computer can automatically access the host server via the Internet, and where the patient can access his or her own files by inserting a PIN or other identifying password to access the patient's own complete medical history. The prior art also fails to show a system where the patient or emergency room personnel can obtain a limited, read-only version of the patient history without having the patient's PIN number. The prior proposed systems did not employ a two-way firewall that would permit the patient to read and modify his or her own records, but not the physician's records nor those of other patients, yet permits the physician to modify his own records plus the patient's records.
A number of adverse patient care problems arise from medical record unavailability or mismanagement. One recent study indicates that physicians devote a significant share of their time just to patient care documentation. By making it possible for the physician to devote a higher fraction of time to patient care, the level of care would improve without a cost increase. Also, an estimated 90% of emergency department visits occur without any knowledge of the patient records or of the patient's prior conditions. This can lead to many errors from misdiagnosis. Studies have also shown that 11% of laboratory testing is redundant, and not needed, which adds an additional one billion dollars to medical costs annually. Prescribing or administering contra-indicated drugs to the patient is also a problem, and recent research indicates that a third of all elderly admissions have been the direct result of contra-indicated drugs.
It would be desirable to allow access to the patient's medical records on any standard, general small computer, i.e. laptop or desk top personal computers, where the patient medical history is called up using the computer's Internet browser. The objective is to achieve a better patient through-put for the physician, as the physician would have the patient's entire medical history, including prior diagnoses, prescriptions, immunizations, allergies, and surgeries and procedures when meeting with the patient. The patient would have the ability to maintain the patient's own records, but the system would also allow the physician complete and accurate medical information, with the ability to update the patient's medical data. Having all prior procedures and diagnoses listed would improve accuracy of the medical data and medical histories of patients, and would eliminate unnecessary retesting. The treating physicians and pharmacists would have access to prior medication prescriptions and dosages for the patient, as well as patient allergy and reaction information. Knowledge of what other drugs the patient takes goes a long way towards eliminating the risk of life-threatening prescription interactions.
Desirably, the medical records should be accessible by the doctors or hospital personnel without requiring special training, with the physician's or other care provider's computer providing access to the patient's medical records.
At the present time, Medication Reconciliation is becoming to be recognized for its importance in keeping tabs on what pharmaceuticals patients are taking, both at home and in hospital. This is intended to help achieve the national patient safety goal, established by the Joint Commission on Accreditation of Healthcare Organizations, to have all hospitals establish procedures for accurately and completely reconciling medications across the continuum of health care. Medical reconciliation means that upon admission of patients, any medications taken prior to coming to the hospital would be identified by nursing staff and recorded. At present, a Medication Reconciliation Order Sheet (which is a paper form) is used for this purpose. The intention is to include prescription and sample medications, vitamins, vaccines, over-the-counter drugs, and even non-prescribed herbal preparations. The admitting physician or healthcare provider is then responsible for reviewing the patient's medication history, and reconciling the information on the medication history with any new medications that the physician might prescribe. This involves checking for medication interactions and making notes of any new prescriptions or changes to old ones.
This step is a recognition that each time that there is a transition in patient care, there is a potential for errors in medications. Medication Reconciliation upon transfer of a patient is supposed to prevent those errors by ensuring that subsequent healthcare providers are aware of the patient's condition and medication history. This requires constant attention to each patient's Medication Reconciliation file, as the file has to be updated each time the patient starts a new treatment or medication, or changes the dose of an existing medication. The current systems are not automated, and there is still room for human error.
In one recent implementation, the Medication Reconciliation document is a plastic, magnetic folder that contains the individual's important health and medication information. The patient can place this on the home kitchen refrigerator, so that emergency medical professionals would have access to the patient's basic medical information in the event of an emergency. The information recorded in this file would include medications taken, allergies, medical conditions, emergency contact information, blood type, and name of physician.
It would also be desirable to have a single unified system that both keeps the patient records for all the participating patients, and provides access to the patient's health records at remote sites over the Internet.